Five cases of congenital pseuduthrosis of the tibia were treated at Department of Orthopedic Surgery, Yonsei Medical Center from September 1971 to February 1982. In four cases, many cafe-au-lait spots were shown on the whole body skin, which are suggestive of neurofibromatosis. The evidence of hereditary factor is elicited on Case 2. Satisfactory bony union occurred in Case 1 & 3 in which the delayed autogenous bone graft was used. Among various methods of treatment of the congenitaeudarthrosis, in this study, the delayed autogenous bone graft and the free vascularized bone graft was recommended.
Cafe-au-Lait Spots ; Fibrinogen ; Neurofibromatoses ; Orthopedics ; Pseudarthrosis ; Skin ; Tibia ; Transplants

Ankylosing spondylitis is a chronic inflammatory disease which most frequently affects the sacro-iliac joints of young men, and also the synovial joints of the whole spine. Bony fusion of these joints and ossification along the longitudinal ligaments lead to total immobility of the vertebrae. Sixty-two cases of ankylosing spondylitis treated at the Severance Hospital from June 1980 to June 1986 were analysed clinically and the followings were obtained. 1. The average age was 38 years and the sex ratio between the male and the female was 58: 4(Male=94%). 2. The most frequent location of pain was low back (32%), and the pain was usually bilateral (81%). 3. The main stiff regions were the hip joint (35%) and the lumbar spine (27%). 4. The most frequent joint affected was the hip (44%), and the extraarticular manifestations were pleuropulmonary disease (29%), gastrointestinal disorder (15%), iritis (10%), etc. 5. The characteristic X-ray findings were sacro-iliac changes (72%), facet joint blurring (53%), and syndesmophyte (37%). 6. Laborstory findings showed increased ESR (85%), positive HLA B-27 (97%), negative rheumatoid factor (94%), and the serum immunoglobulins snd complements were not decreased.
Clinical Study ; Complement System Proteins ; Female ; Hip ; Hip Joint ; Humans ; Immunoglobulins ; Iritis ; Joints ; Longitudinal Ligaments ; Male ; Rheumatoid Factor ; Sex Ratio ; Spine ; Spondylitis, Ankylosing ; Zygapophyseal Joint

The depth of wound level is as important as the level of the tendon injury itself. And the timing of the operative procedure is an important factor. As a rule, tendons injured outside of the flexor sheath yield much better results than those injured within the sheath. The nutritional supply of the flexor tendons is not completely understood. Many elaborate studies have outilned the vascular anatomy of these tendons, and not all authors are in agreement. It is now clear that synovial fluid within the sheath supplies nutrition to the tendon much as synovial fluid in a joint supports cartilage. With this in mind, the present study was designed to determine the effect of exposing tendons for varying periods of time on the viability of the tendon and sequential morphological changes. The results are as follows: 1. Twelve hours after tendon sheath removal, collagen fibrillar dissociation and irregular surface of the tendon sheath were noted on the chicken flexor tendons by electronmicroscopy. 2. Superficial tenocyte necrosis was created after 24 hours of tendon exposure. 3. At 3 days, inflammatory cell infiltration and thickening of the outer synovial layer were noted. After 7 days, fibrosis of the degenerated tendon started from the exposed surface. 4. The fibrous connective tissue and new blood vessel infiltration into the tendon were progressed after 7 days. From these morphological results, any interference with the synovial environment leads to a regressive change of the flexor tendons immediately. It is suggested that delayed primary wound covering procedure within three days an after exposed tendon injury is ideal, and it should by done at least 7 days after tendon exposure.
Blood Vessels ; Cartilage ; Chickens ; Collagen ; Connective Tissue ; Equipment and Supplies ; Fibrosis ; Joints ; Necrosis ; Surgical Procedures, Operative ; Synovial Fluid ; Tendon Injuries ; Tendons ; Wounds and Injuries

Low back pain and sciatica is one of the most frequent and troublesome problem in the orthopedic field. A study of the effectivity and reliability of the anterior interbody fusion with autoiliac bone graft for the spondylogenic and Discogenic back pain was done on 166 patients who had been hospitalized from January 1978 to December 1984. The approach to the lesion was retroperitoneal with anterior approach. The anterior interbody fusion was performed by using one block or two block from autoiliac bone. The status of the spine fusion after operation was decided by the plane roentgenogram or clinical sign, and the tomogram or dynamogram in some case. We analysed 116 patients having anterior fusionto study whether fusion rate has any relation with the number of the grafted bone, preoperative diagnosis and the level of fusion. At 9 months after operation, the clinical result was assesed and was compared between the group of the preoperative diagnosis. The following results were obtained from analysis of the cases studied. 1. The fusion rate for the grafted bone was 92.2%. There was no difference in fusion rates between the group of patients operated using one block and two-block. 2. The fate of the grafted bone could be categorized into 5 different types. 3. In patients with spondylolisthesis or spondylolysis, there was high incidence of non union.Also in terms of the vertebral level, the fusin between the L5-Sl showed high incidence of non union. 4. High fusion rate was obtained by using back brace without cast immobilization. The average duration of brace wearing was 6.6 months. 5. Overall clinical results were as follows:excellent or good 64.6%, fair 31.9%, poor 3.5%,and spondylolisthesis showed better clinical results than other diseases. 6. Post sympathectomy symptoms were noticed in 12 patients after operation and there were no permanent genitourinary problem.
Arthrodesis ; Back Pain ; Braces ; Diagnosis ; Equidae ; Humans ; Immobilization ; Incidence ; Low Back Pain ; Orthopedics ; Receptors, CXCR4 ; Sciatica ; Spine ; Spondylolisthesis ; Spondylolysis ; Sympathectomy ; Transplants

No abstract available.
Arteriovenous Fistula* ; Fistula*

In recent years the rate of the spine Injury tends to be on the increase year by year as the rate of traffic and industrial accidents are increased. During industrial, sports and automobile accidents are occurred, the various forces were exerted by the mechanism, “flexion, extension, flexlon-rotation, vertlcal compression and shearing.” These exercise their effects on the vertebral bodies, the neural arches and intervertebral disc and the contents of the spinal cord, depending on direction and intensity of the trauma, and the posture and muscular attitude existent at the movement. Once the neurological Iesion has been diagnosised and the type of vertebral injury has been established and particularly after a decision has been made as to whether the spinal injury is stable or unstable, a rational method of treatment can be decised upon: Our treatment consists of providing the best condition for recovery from the spine injury, preventlng further neurologlcal damage in the unstable area, achieving stable bone and llgament heallng ln satisfactory position, preventing metabolic compllcations from being fatal, mobllizing the patient early, and rehabilitating to provide maximum fuctlonal independence with the remaining-muscle power avallablc to the cord injury patient. One hundred and fifty seven spine fracture and dislocation patients were clinically observed and evaluated from Jan. 1972 to Dec. 1978 in our study. The result of this study may be summerized as follows: 1. Out of the patients, there were 135 male and 22 female cases. The ratio between male and female was 6.1:1. The majority (84.7%) of the spine injuries was found in the age of 20 to 50 years. Fifty-two percent of the cases was caused by industrial accidents. 2. The most common site of the lesion occurred between T-11 and L-2 vertebrae (71.8%). 3. In cervical injury, fracture dislocation type was most common (50%), and especially, pure dislocation by extension mechanism was 12.5% but in thoracolumbar iniury, simple anterior wedge compression fracture was most common (66.6%) and there were no pure dislocations just like cervical spine injury cases. 4. Fifty seven cases of the total were complicated by paraplegia, of which 62.5% in cervical region and 31.6% in thoracolumbar region were noticed. The most frequent type of the injury in which paraplegia developed was the fracture dislocation (73.8%) and the most common site of the lesion was between the T-12 and the L-2 vertebrae. 5. Open reduction was performed in 9 cases out of 24 cervical spine injury patients and in 41 cases out of 133 thoracolumbar injury patients. 6. Prognosis of neurologic recovery in initially complete lesion was poor, regardness of treatment. In the cervical lesion cases there were no patients who were recovered. But in the other sites about 10.5% of initially complete lesion showed partial neural recovery comparing to 62.5% of initially incomplete lesions. 7. Progressive deformity is often noted as a complication of spine fracture or dislocation when solid fusion fails to develop. The increment of kyphosis after treatment is as follows: Simple wedge fracture
Accidents, Occupational ; Automobiles ; Catheterization ; Catheters ; Clinical Study ; Congenital Abnormalities ; Diagnosis ; Dislocations ; Female ; Fractures, Compression ; Humans ; Intervertebral Disc ; Kyphosis ; Laminectomy ; Male ; Methods ; Paraplegia ; Posture ; Prognosis ; Spinal Cord ; Spinal Injuries ; Spine ; Sports ; Urinary Bladder

Transient synovitis is characterized by the development of pain arising from the hip and often felt in the thigh or knee in children between the ages of 2 and 12 years. The benign self-limiting nature of this condition has made it difficult to establish the caus'e. However, the condition is generally conceded to be the commonest cause of a painful hip in childhood. The disease is of interest, not because of its disabling condition, but because of the difficulty in differentiating it from more serious diseases of the hip, such as tuberculosis, osteomyelistis, or Legg-Perthes disease. The author had studied the clinical symptoms and signs, roentgenologic findings, and treatment of the 34 patients who had admitted to Severance Hospital Yonsei Medical Center in Seoul, Korea from January 1970 to December 1979, under the diagnosis of the transient synovitis of the hip and summerized the results as follows; 1. There was probably associated with predisposing factors such as infection and allergy. 2. Among the 34 patients, 28 cases(82.4%) were male and 6 cases(17.6%) were female. The most prevalent age were between 6 and 10 years old. 3. Pain and limitation of motion of the hip joint were the most common symptoms. In 56.5% of the patients, roentgenographic findings were positive. In 50% of the patients, the erythrocyte sedimentation rates were increased. 4. The treatment was conservative including bed rest, skin traction on the affected leg, non-weight bearing, antibiotics, and sedatives. Most of all patients had improved symtoms and signs within two weeks of treatment. 5. The course of this condition was short and benign with complete resolution. The occasional hip with chronic or recurrent symptoms could be distinguished from Legg-Perthes disease by the short history, normal radiographs, and the complete resolution.
Anti-Bacterial Agents ; Bed Rest ; Blood Sedimentation ; Causality ; Child ; Clinical Study ; Diagnosis ; Female ; Hip Joint ; Hip ; Humans ; Hypersensitivity ; Hypnotics and Sedatives ; Knee ; Korea ; Leg ; Legg-Calve-Perthes Disease ; Male ; Seoul ; Skin ; Synovitis ; Thigh ; Traction ; Tuberculosis

Ossification of the ligamentum flavum (OLF) has been recognised as a definite clinical entity as an ossification of the posterior longitudinal ligament. It has been known that the incidence of OLF is high in Japan and OLF usually occurs in the thoracic and lumbar region. Recently OLF has received considerable attention as a cause of myelopathy. OLF is quite distinct from “hypertrophy” of the ligamentum flvum. We experienced 2 cases of OLF with neurological symptom, which were treated by decompressive laminectomy and removal of the ossified ligamentum flavum. So remarkable symptomatic improvement was obtained.
Incidence ; Japan ; Laminectomy ; Ligamentum Flavum ; Longitudinal Ligaments ; Lumbosacral Region ; Spinal Cord Diseases ; Spine

Lumbar spinal stenosis is a common category of spinal disease in which a decrease in the volume of the spinal canal results in compression of the neural elements. Its pressure symptoms are characterized by vague back-pain and chronic sciatica. The goals of surgical treatment in lumbar spinal stenosis are the relief of pain and the preservation or restoration of neurologic function. Extensive laminectomy in lumbar spinal stenosis results in postoperative instability and postoperative vertebral subluxation with pain, restricted movement, and further neural compression occurs after decompressive laminectomy. Therefore internal fixation devices have been used in these circumstances to prevent postoperative instability while the fusion being consolidated. From February 1988 to October 1988, 36 patients of lumbar spinal stenosis had undergone operations with decompressive laminectomy and segmental spinal instrumentation with transpedicular screws at the department of Orthopaedic Surgery, Yonsei University College of Medicine. In 18 patients degenerative changes in lumbar spine were the principal aetiologic factor:7 patients had spondylolisthetic spinal stenosis:ll patients had combined spinal stenosis. All patients were followed up for periods varying between twelve and ninteen months. According to Kim's criteria, the postoperative results were as follows;excellent in 17 cases(47.2% ), good in 15 cases(41.7% ) and fair in 4 cases(11.1% ). The study revealed that segmental spinal instrumentation with transpedicular screws provided a rigid fixation, early ambulation, minimal fusion and reducing of recovery period were possible. In conclusion, segmental spinal instrumentation with transpedicular screws is a good and reliable method of stabilization after extensive decompressive laminectomy.
Early Ambulation ; Humans ; Internal Fixators ; Laminectomy ; Methods ; Sciatica ; Spinal Canal ; Spinal Diseases ; Spinal Fusion ; Spinal Stenosis ; Spine

With the increasing number of the occupational accidents proportionate to the rapid development of modern culture, fractures of the hand have become one of the commonest fractures of the human body. The authors have reviewed 211 cases of injured hand in industry which were treated in the department of orthopedic surgery, InCheon Severance hospital from Jan. to Dec. in 1989. The following results were obtained; 1. The peak incidence was in the age group from 21 to 30 years in 87 cases (41.2%). Injured males outnumbered females predominantly by 92.9% vs 7.1%. 2. The hand injuries happened most commonly in the day time (from 8 oclock A.M. to 6 oclock P.M.) but there were no differences between month in the year. 3. Most of patients injured hand (73.9%) arrived at hospital within 1 hour after accidents. 4. The commonest cause of the injury was due to electric saw (21.9% ). 5. Of the 98 fracture cases left hand was more frequently involved than right hand and 64 cases monodigit and remained were polydigits. 6. 43 (32.6%) of total 132 fractured sites were index finger and 74 (56.1%) were distal phalanx. 7. The index finger was also most vulnerable to amputation (56.8% out of 44 amputation cases) and the most distal part was more vulnerable to amputation. 8. The most common method was primary closure and splint. The method of treatment was affected in part by the economic and social status of the patients. 9. In order to prevent hand injuries in industry, preventive policy should be established by improvement of working environments, machines and education.
Accidents, Occupational ; Amputation ; Education ; Female ; Fingers ; Hand Injuries ; Hand ; Human Body ; Humans ; Incheon ; Incidence ; Male ; Methods ; Orthopedics ; Splints